Provider Demographics
NPI:1780983494
Name:GARY, CERISE F (CNA/HM/COMPANION)
Entity type:Individual
Prefix:MS
First Name:CERISE
Middle Name:F
Last Name:GARY
Suffix:
Gender:F
Credentials:CNA/HM/COMPANION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4014
Mailing Address - Country:US
Mailing Address - Phone:203-589-0081
Mailing Address - Fax:
Practice Address - Street 1:404 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4014
Practice Address - Country:US
Practice Address - Phone:203-589-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTNA9988838374U00000X
CT#HCA.0000529376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide